Objective: Report a case of blepharospasm secondary to PUVA therapy

Background: Blepharospasm is a focal dystonia that can present as spasms of the eyelids, involuntary eyes’ closure, enhanced spontaneous blinking or any combination of these. Primary blepharospasm usually starts in adulthood and is the most frequent type. Its secondary form has been described in cases of structural brain lesions, prolonged exposure to certain drugs and neurodegenerative diseases, such as parkinsonian syndromes. Although it has been described as a presenting symptom of photokeratitis, it has never been associated with other forms of structural or iatrogenic ocular lesions, such as psoralen and ultraviolet A (PUVA) therapy.

Method: Retrospective analysis of the patient’s’ clinical registries

Results: A 50 years old woman, with a past medical history of psoriatic arthritis, presented to our emergency department in 2002 complaining of sudden blurred vision and headache worsened by eye movements and accompanied with phono and photophobia. A month before she had been subjected to PUVA for psoriatic lesions and developed severe and extensive burn injuries all over her body. Neurological examination was striking for diminished pupillary reflex in the right eye, complex gaze ophthalmoplegia and enhanced blinking. In the following appointments she kept the enhanced blinking and severe photophobia with a permanent need for orange filter glasses, even in the dark. Without them she is functionally blind and the eyes are in permanent supraversion. She has been treated with botulinum toxin, with improvement of the blepharospasm.

Conclusion: Blepharospasm is a rare dystonia much more common in it’s primary form. Even though it has already been described as a secondary form of numerous etiologies, this is the first case report of blepharospasm after PUVA, presenting in a severe and disabling way.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-severe-blepharospasm-after-psoralen-and-ultraviolet-a-treatment/